Mucha P
Mayo Clin Proc. 1986 Jun;61(6):472-7. doi: 10.1016/s0025-6196(12)61983-1.
During the past decade, one of the most controversial issues in the surgical literature has been the question of what is the most appropriate management of splenic trauma. An increased understanding of the physiologic importance of splenic function must now be weighed against the life-threatening risk of exsanguinating splenic hemorrhage. In this article, postsplenectomy sepsis and mortality in adults and the selective management of blunt splenic trauma are discussed. Although the risks of postsplenectomy sepsis and serious infection are low, they do exist. A policy of individual assessment of cases is recommended when the merits of splenectomy versus those of splenic preservation are considered. Similarly, in cases of blunt splenic trauma, a policy of individual assessment is not only intellectually attractive but also safe, rational, and effective from a clinical standpoint. In selected cases of blunt splenic trauma, nonoperative management and splenorrhaphy are acceptable alternatives; however, in many instances splenectomy remains the most appropriate and only course of action.
在过去十年中，外科文献中最具争议的问题之一一直是脾外伤最恰当的处理方法是什么。现在，必须在对脾功能生理重要性的进一步认识与脾出血导致危及生命的风险之间进行权衡。本文讨论了成人脾切除术后的败血症和死亡率以及钝性脾外伤的选择性处理。虽然脾切除术后败血症和严重感染的风险较低，但确实存在。在考虑脾切除术与脾保留术的优缺点时，建议采用个案评估政策。同样，在钝性脾外伤病例中，个案评估政策不仅在理论上具有吸引力，而且从临床角度来看也是安全、合理和有效的。在某些钝性脾外伤病例中，非手术治疗和脾修补术是可接受的替代方法；然而，在许多情况下，脾切除术仍然是最合适且唯一的行动方案。
